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Strategic Planning for Electronic

Medical Records in Long Term Care

September 22, 2010

Stephen Pacicco Kevin A. Stagg Jennifer Vitrano D’Angelo

Chief Executive Officer Executive VP & CFO DirectorSoftware Implementation

SigmaCare Christian Health Care Center Christian Health Care Center

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Agenda

• Introductions

• Current LTC Environment and Upcoming Changes

• How EMR’s Address the Challenges and Opportunities

• What’s in an EMR

• Strategic Planning for Implementation of an EMR

• Christian Health Care EMR Process & Results

• Conclusions & Questions

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The Current LTC Environment

The Long Term Care industry is changing:

• MDS 3.0 changes reimbursement

• Operational efficiency will be critical

• Collaboration among all providers of care will be

required - includes LTC facilities, pharmacy

consultants, therapy, labs, radiology, etc.

• Increased quality expectations, reporting and

monitoring will be needed

• Health care reform puts more emphasis on

technology

Electronic Medical Records (EMR’s) are needed to

turn these changes into opportunities

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Why Implement An EMR

EMR’s facilitate immediate compliance and long term gains

• EMR’s help capitalize on LTC market changes

– Increase reimbursement due to accurate ADL and rehab minute documentation

and the ability to electronically capture all care given (needed for MDS 3.0)

• EMR’s promote effective and efficient facility management

– Eliminate paper inefficiencies, i.e. faxing orders, re-documentation

– Document and monitor facility workflow on a real-time basis

– Decrease in nursing paperwork hours allowing more time for quality care

• EMR’s facilitate risk mitigation

– Track the average number of meds ordered and tasks documented per day

– Provide allergy alerts and formulary checks

– Prepare facilities for seamless and successful surveys

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What’s In A Long Term Care EMR

Document Management & Paperless Charts

Rehabilitation Charting & Charge Capture

CNA Assignments & Nursing Instructions

Automated MDS Workflow & Care Planning

Clinical Assessments

Progress Notes, 24-Hour Reporting, A&I Tracking

Online Lab Results and Lab Monitoring Policies

Electronic Medication/Treatment Administration Record (eMAR/eTAR)

Computerized Physician Order Entry (CPOE)

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How Long Term Care EMR’s Interface

EMR’s engage with Pharmacies, Labs and Financial

systems to facilitate electronic data transmission

leading to a paperless, more efficient workflow

EMRFacility

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How to Prepare for EMR Implementation

• Set clinical, financial and organizational

goals for your facility

• Establish firm project governance team to

help strategically plan for implementation– Set a facility vision

– Educate staff from the ground up

– Identify champions for each department

• Facilitate change management to address

gaps in transition process– Adequate staffing and support during process

– Require 100% attendance for job-based,

hands-on training

– Entrench the facility in the implementation

process – everyone must be onboard!

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Implementation Process & Timing

Pre-Implementation & Project Oversight(3 .5 months – entire implementation process)

Project Governance/

Project Management

IT Infrastructure

(1 Month)

Workflow Analysis

(1 week)

Outcomes Data

Collection

(On-Going)

Readiness & Configuration(3 months)

Change Management

System Setup and

Configuration (3 Months)

Go-Live Activities(2 months)

TrainingData

Validation

Peer Mentor Program

Go-Live Support

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EMR Process & Results

Christian Health Care Center:

Heritage Manor, Southgate, Ramapo Ridge & Longview

Location: Wyckoff, NJ

Beds: 445 total

Services: Skilled nursing, special care inpatient nursing, behavioral

management treatment, psychiatric and assisted living

EMR Implementation Timeline (Heritage Manor)

CPOE/eMAR/MDS/Care Planning

Onsite Training: 7/16–7/22/08

Go-live Activities: 7/23–8/3/08

Live All Units: 8/03/08

CNA Assignments

Onsite Training: 8/06–8/12/08

Go-live Activities: 8/13–8/24/08

Live All Units: 8/24/08

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Our Approach: 100% Involvement

• Get everyone excited for the paper to

electronic transition

– Everyone from Physicians to CNA’s are on-

board with the process

• Treat your relationship with your EMR

provider as a partner not a “vendor”

– Work together to drive facility goals and

outcomes

• Use your EMR to the fullest

– Take advantage of facility management

and reporting features

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Our Results: High Adoption Rates at Heritage

eMAR Documentation - 99.5% On Time

93.00%

94.00%

95.00%

96.00%

97.00%

98.00%

99.00%

100.00%

CNA Documentation – 99.2% On Time

82.00%

84.00%

86.00%

88.00%

90.00%

92.00%

94.00%

96.00%

98.00%

100.00%

Formulary – 99.7% Compliant

98.20%

98.40%

98.60%

98.80%

99.00%

99.20%

99.40%

99.60%

99.80%

100.00%

12/2/2008

1/2/2009

2/2/2009

3/2/2009

4/2/2009

5/2/2009

6/2/2009

7/2/2009

8/2/2009

9/2/2009

10/2/2009

11/2/2009

12/2/2009

1/2/2010

2/2/2010

3/2/2010

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Our Results: High Adoption Rates at Southgate

eMAR Documentation – 99.7% On Time

86.00%

88.00%

90.00%

92.00%

94.00%

96.00%

98.00%

100.00%

CNA Documentation – 99.8% On Time

84.00%

86.00%

88.00%

90.00%

92.00%

94.00%

96.00%

98.00%

100.00%

Formulary – 98.8% Compliant

90.00%91.00%92.00%93.00%94.00%95.00%96.00%97.00%98.00%99.00%

100.00%

12/2/2008

1/2/2009

2/2/2009

3/2/2009

4/2/2009

5/2/2009

6/2/2009

7/2/2009

8/2/2009

9/2/2009

10/2/2009

11/2/2009

12/2/2009

1/2/2010

2/2/2010

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Our Results: High Adoption Rates at Ramapo

eMAR Documentation – 98.2% On Time

90.00%

91.00%

92.00%

93.00%

94.00%

95.00%

96.00%

97.00%

98.00%

99.00%

100.00%

10/13/2008

11/13/2008

12/13/2008

1/13/2009

2/13/2009

3/13/2009

4/13/2009

5/13/2009

6/13/2009

7/13/2009

8/13/2009

9/13/2009

10/13/2009

11/13/2009

12/13/2009

1/13/2010

2/13/2010

3/13/2010

80.00%

82.00%

84.00%

86.00%

88.00%

90.00%

92.00%

94.00%

96.00%

98.00%

100.00%

12/2/2008

1/2/2009

2/2/2009

3/2/2009

4/2/2009

5/2/2009

6/2/2009

7/2/2009

8/2/2009

9/2/2009

10/2/2009

11/2/2009

12/2/2009

1/2/2010

2/2/2010

Formulary – 99.2% Compliant

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Our Results: Increased Reimbursement

• Medicare Part A rate

increased by 11% resulting

in increased reimbursement

– Pre EMR implementation,

the Medicare Part A rate

was $523

– Post EMR implementation,

the Medicare Part A rate

was $582

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Our Results: Operational Cost Savings

• Staffing hours decreased by 2% due to decline

in additional paper work needed from prior paper

process

– Pre EMR implementation, total staffing hours

was 87,800

– Post EMR implementation, total staffing hours

was 86,900*

* Includes elimination for EOM recaps 80 hours overtime

per pay period ($35,000 savings per year FTE)

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Our Results: Additional Benefits

Optimal survey results - year 2009

recorded best survey results in 10 years

Decline in shift to shift paperwork and

reporting

Increase in direct resident care

Increase in Physician and Nurse work

place satisfaction

Increased documentation efficiency due

to streamlined reporting and remote and

real-time access

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Questions & Answers